Objective To explore the accurate positioning of Kawase triangle area via intradural anterior subtemporal transpetrosal approach. Methods On 14 dry skulls, the highest point of arcuate eminence (A), the junction of lateral margin of petrous ridge and anterior margin of transverse sinus (J), the petrous apex (P), the outermost point of sulcus nervi petrosi superficialis majoris (B), the outermost point of foramen spinosum (C), the outermost point of foramen ovale (D), the outermost point of trigeminal notch (E), and the outermost point of foramen lacerum (F) were marked. The distances of JA, JB, JC, JD, JE and JF were measured using point J as reference point. Using the line (JP) between point J and point P as the baseline, the angles of baseline with JA, JB, JC, JD, JE, and JF were measured. Results There were no significant differences in the distances of JA, JB, JC, JD, JE and JF between the left and right sides (P>0.05). There were no significant differences in the angles of the baseline with JA, JB, JC, JD, JE, and JF between left and right sides (P>0.05). Conclusion Using point J and the baseline JP as referent indexes, bony structures can be precisely located via intradural anterior subtemporal transpetrosal approach to orientate the Kawase triangle area; this method can insure rapid, accurate and safe drilling of anterior petrosal bone and exposing of petroclival region.

Objective:To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage. Methods:One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study; 51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope (neuro-endoscopy group) and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope (microscopy group). The clinical data of these patients were retrospectively analyzed; and the differences of hematoma clearance rate, intraoperative blood loss, duration of surgery, length of hospital stays, Glasgow Coma Scale (GCS) scores one week after surgery, incidence of postoperative complications, and activity of daily living (ADL) scores 6 months after surgery were compared between the 2 groups. Results:There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups ( P>0.05). As compared with the microscopy group, the neuro-endoscopy group had significantly lower intraoperative blood loss, significantly shorter duration of surgery, and statistically higher GCS scores one week after surgery ( P<0.05). There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups ( P>0.05). Conclusion:Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function; however, surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss, and earlier neurological function recovery.